About the Procedure
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Portal hypertension can occur due to an increased resistance to flow at three levels (a) before the portal veins drains into the liver (b) within the liver due to changes in the liver tissue (Cirrhosis) and (c) due to a block on the veins that drains blood from the liver to the heart(Budd Chari's syndrome) .
By and large the commonest cause of portal hypertension is Cirrhosis liver .Here the soft liver is replaced by tough fibrous tissue . This causes a significant increase in the resistance to blood that flows from the portal vein into the liver.
Procedure Details
Causes of Portal Hypertension
Portal hypertension can occur due to an increased resistance to flow at three levels (a) before the portal veins drains into the liver (b) within the liver due to changes in the liver tissue (Cirrhosis) and (c) due to a block on the veins that drains blood from the liver to the heart(Budd Chari's syndrome) .
By and large the commonest cause of portal hypertension is Cirrhosis liver .Here the soft liver is replaced by tough fibrous tissue . This causes a significant increase in the resistance to blood that flows from the portal vein into the liver.
 The body tries to circumvent this increased resistance by developing channels that directly connect the portal vein to the Vena-cava. These abnormal vessels often lie in the walls of the stomach and esophagus(varices) . They often rupture and bleed and may even result in death.The fist line of therapy for bleeding varices is through an endoscope where the physician or surgeon will either inject a special glue or use medical elastic rings to stop the bleeding . A small group of patients continue to bleed despite this treatment. These patients would benefit from Trans Jugular Porto Systemic Stenting (TIPSS) . TIPSS is also the treatment of choice when liver transplant is contemplated in a cirrhotic patient with variceal bleeding.
TIPSS is indicated in patients who have bleeding varices that cannot be adequately controlled by by sclerotherapy or banding . Intractable ascites in patients with portal hypertension. Budd Chari syndrome due to occlusion of the hepatic veins.
Procedure
 The procedure is performed under general anesthesia. The jugular vein is punctured and a catheter is navigated under imaging guidance into the hepatic vein the catheter is then exchanged for a sheath. A specially designed needle is used to puncture the portal vein through the hepatic vein the tract of liver tissue is then dilated and the segment further treated with a specially designed stent .
Following the procedures the blood pressure in the portal Veins drop as the blood now flows from the portal vein directly to the Inferior Vena Cava through the stent graft.(View Animatiom) .Following the procedure most patients have significant relief. Patients are kept under followup since there is a 25% chance of a further block developing within the stent graft.
Complications
Though rare the following complications can take place. a) Bleeding leading to death.
b) Misplacement of the stent.
c) Worsening of symptoms leading to coma and death.
d) Stent occlusion early and late. Case Study
Cirrhosis liver with portal hypertension |
